Discharge practices in skilled nursing facilities affected by COVID-19 [Meeting Abstract]
BACKGROUND: Many patients require post-acute care at skilled nursing facilities (SNF) after hospital discharge. While returning from SNF to home is often the ultimate goal for these patients, a safe discharge from SNF often requires additional support from home health care agencies or from patients' families. However, the COVID-19 pandemic affected all aspects of the healthcare industry, complicating transition home. To understand how post-acute SNF throughput was affected by the COVID-19 pandemic, we conducted a study of discharge processes of patients with COVID-19 at a skilled nursing facility.
METHOD(S): This was a retrospective study of all residents at our SNF with a positive COVID-19 PCR test between 3/1/20-6/1/20. We defined post-acute patients as those who were admitted to the nursing home 100 days or less before the positive test. Using the facility's electronic medical record, we reviewed all medical, nursing, social work and other notes to identify discharge planning processes. Specifically, we identified if discharge planning was initiated, whether the patient was successfully discharged, and whether there was evidence that the discharge was complicated by COVID-19 related challenges.
RESULT(S): Of 350 residents with a positive COVID-19 PCR, 121 were postacute patients who were admitted to our facility within 30 days of positive PCR or symptom onset. Median age was 79 (interquartile range [IQR], 69-86), 59 (49%) were female, 16 (13%) were Black, 8 (7%) were White, 8 (7%) were Hispanic and 84 (70%) did not report race. Over an average follow-up time of 185 days, 98 (81%) post-acute patients had discharge planning initiated, of which 81 were discharged to the community. Median length of stay for those discharged was 38 days (IQR 23-98). Discharge sites included home (66 [81%]), assisted living facilities (9 [7%]), and hotels (2 [2%]). Discharge planning was affected by COVID-19 for 49 (41%) patients. These included symptom development that precluded discharge; logistical issues related to establishing home oxygen; unwillingness for assisted living facilities, home care services, or families to receive COVID-19 positive patients; challenges establishing home care services due to staffing shortages; and family members sick with COVID-19 themselves.
CONCLUSION(S): The COVID-19 pandemic had a multi-layered effect on the ability of nursing home residents to be discharged safely home. LEARNING OBJECTIVE #1: Practice-Based Learning and Improvement: A diagnosis of COVID-19 has a substantial impact on the ability to safely discharge patients from SNF due to concerns from assisted living facilities, home care services, and families about directly caring for someone with COVID-19. LEARNING OBJECTIVE #2: Systems-Based Practice: Delayed discharge from SNF may impact their ability to accept new patients, which may have further upsteam effects on other aspects of the healthcare continuum such as hospital length of stay
American College of Allergy, Asthma & Immunology Patch Testing and Allergic Dermatologic Disease Survey: use of patch testing and effect of education on confidence, attitude, and usage
BACKGROUND: The patch test is an important tool for the diagnosis of contact dermatitis. In the past few years, allergists have shown increased interest in the diagnosis of contact dermatitis and the use of patch testing. OBJECTIVE: The aim of this study was to determine (1) the frequency of usage of the patch test among allergists, (2) the factors that affect the decision to patch test, and (3) the need for training the allergist to perform patch testing. METHOD: A single mailing survey was sent to all the members of the American College of Allergy, Asthma and Immunology (ACAAI). RESULTS: Fifty-seven percent of responding allergists performed patch testing but did so infrequently. Those who were fellowship trained in patch testing or attended a sponsored workshop performed the test more frequently than those with no training. Those who perceived the patch test as useful also were more likely to perform the test. Fellowship-trained members felt more confident than workshop-trained members in performing the test, and both, in turn, were more confident than members with no training. Trained physicians also were more likely to find the test useful compared with those with no training in patch testing. CONCLUSIONS: Education through fellowship training and workshop was associated with greater self-confidence of the allergist in his/her ability to perform patch testing. Education also was associated with increased perception of patch test utility and increased usage of the test.